Mari Paz Castanedo-Tardan

Contact Allergy: alternatives for the 2007 North American contact dermatitis group (NACDG) Standard Screening Tray.

ost primary care physicians see a large number of patients each year ith eczematous skin diseases. Although many of these patients have topic eczema, another extremely common cause of eczema is contact llergy. This subgroup of eczema patients is notably resistant to treatment nless the causative allergens can be identified and eliminated. It is stimated that allergic contact dermatitis (ACD) to topical products alone ccurs in 1% to 3% of the general population. Unlike respiratory and ood allergies, ACD is not histamine-mediated but is instead a T-cellediated delayed-type hypersensitivity reaction. The basic pathophysilogic process behind ACD is primary skin contact with an allergenic hemical which triggers an immune cascade and results in an eczematous eaction at the site of contact. On first exposure to low molecular weight chemical substances (haptens 500 Da), there is generally no skin reaction. During this first phase, hese haptens enter the epidermis and are recognized by antigen presentng cells, which in turn create signals that transform naive T cells into emory T cells, a process which typically takes 5 to 25 days. ubsequent reactions due to “challenge” with the same chemical subtance generally occur between 24 and 48 hours after exposure; however, eports of reactions occurring as early as 8 hours after exposure and as ong as 1 week after exposure are not uncommon.

Patterns of Cosmetic Contact Allergy

Certain patterns of dermatitis, such as those affecting the face, eyelids, lips, and neck, should raise the suspicion of a cosmetic-related contact allergy. Patch testing with a broad screening series, supplemented by a patients own personal care products, should be considered when evaluating patients with suspected cosmetic dermatitis. Once the offending allergen is identified, an avoidance regimen should be established to avoid further exposure.

Pharmacotherapy for allergic contact dermatitis

Allergic contact dermatitis is a highly prevalent, potentially chronic disease, with a significant economic and quality of life impact. Culprit causal allergen(s) can be identified though patch testing, the ‘gold-standard’ diagnostic method. For most people, identification and subsequent avoidance of their clinically relevant allergens will results in resolution of the dermatitis. However, when an avoidance regimen is not possible, or an allergen is not identified, patients potentially require symptomatic and immunosuppressive therapy to diminish the manifestations of their disease. This article reviews a therapeutic approach to allergic contact dermatitis.

Allergic contact dermatitis to propolis and carnauba wax from lip balm and chewable vitamins in a child

A 6-year-old girl with a history of mild atopic dermatitis since infancy was referred for recurrent episodes of cheilitis, which was accompanied by a facial and upper extremity dermatitis. Patch-testing was performed with selected chemicals (based on exposure history) from the North American Contact Dermatitis Standard and Vehicles, Textiles, Bakery, Fragrances, and Plastics andGlues extended series. Clinically relevant positive reactions were noted to propolis and cinnamaldehyde.Additional reactions with uncertain relevance were noted to potassium dichromate, sorbitan sesquiolate, octyl gallate, and disperse blue dyes (85 and 153). A provocative use test with the child’s lip balm (Chap Ice Gentle Lips Cherry Lip Protectant Balm by OraLabs Inc., Parker, CO,USA)containingnaturalandartificial flavors and menthol in a ‘wax base’ showed a positive reaction. A topical avoidance regimen was begun and on follow-up there was significant improvement. Further discussion showed that she had begun consuming multivitamins, namely Flintstones Gummies chewable multivitamins (by Bayer HealthCare Leverkusen, Germany), which notably contained an ‘unspecified’ amount of carnauba wax and bees wax (Bayer HealthCare Consumer Relations, personal communication, July 2007). Of note, discontinuation of the vitamins resulted in clearance of both the cheilitis and dermatitis.

Effects of lavender olfactory input on cosmetic procedures

Objectives  To evaluate the effects of the aroma of essential oil of lavender against placebo on subjects’ pain perceptions and levels of anxiety when undergoing elective cosmetic facial injections of botulinum toxin type A (BOTOX® COSMETIC) for the correction of glabellar wrinkles.

Allergic contact dermatitis to sorbitan sesquioleate in children.

Sorbitan sesquioleate (SS; Arlacel 83 , Sigma-Aldrich Co., St. Louis, MO, USA) is a fatty acid ester derived from a mixture of monoand diesters of oleic acid and hexitol anhydrides of sorbitol (1). It is an oil-soluble, water-dispersible, and non-ionic surfactant, which functions as a waterin-oil emulsifier, increasing skin permeability and changing the physicochemical characteristics of other compounds (2). It is used widely in cosmetics, ointments, creams, lotions, pharmaceutical preparations, agrochemicals, inks, and paints (3). While allergic contact dermatitis (ACD) from emulsifiers has been reported (4), this case series present the first report of clinically relevant SS contact allergy described in children.

Dermatitis por contacto en Pediatría: revisión de opiniones actuales

In the not so distant past, in the United States contact dermatitis was considered to be a condition that affected mainly adults. The diagnosis was certainly less often rendered in pediatrics, mainly because it was believed that a childs immune system was immature and that children were generally exposed to fewer allergens. With this in mind, we can attribute the low prevalence formerly reported for this disease partly to the fact that most affected children were not (and are still not) evaluated using appropriate skin tests. Patch testing in children requires certain modifications, but the international literature of the last decade and US data published in the past year indicate that contact dermatitis is a common condition in the pediatric population and that the prevalence is similar in children and adults.

Ethics of selling skin care

One of the most controversial topics surrounding the practice of dermatology is in-office dispensing of nonprescription skin care products by dermatologists. The controversy is not new, with legitimate arguments debated for and against it. The ongoing debate will continue, emotionally charged and with sharply demarcated battle lines, but without the promise of ever reaching a consensus. Regardless of ones position, the objective is to develop strategies to improve the practice of dermatology and the welfare of patients.

Contact Dermatitis in Children − A Review of Current Opinions

In the not so distant past, in the United States contact dermatitis was considered to be a condition that affected mainly adults. The diagnosis was certainly less often rendered in pediatrics, mainly because it was believed that a childs immune system was immature and that children were generally exposed to fewer allergens. With this in mind, we can attribute the low prevalence formerly reported for this disease partly to the fact that most affected children were not (and are still not) evaluated using appropriate skin tests. Patch testing in children requires certain modifications, but the international literature of the last decade and US data published in the past year indicate that contact dermatitis is a common condition in the pediatric population and that the prevalence is similar in children and adults.

Allergic contact dermatitis to Crocs.

The Crocs footwear (Crocs Inc., Niwot, CO, USA) was first introduced in 2002 at the Ft. Lauderdale Boat Show as a novel ‘light-weight, ventilated, slip and marking resistant’ shoe. Crocs are made from Croslite , a ‘proprietary closed cell resin’, which consists of a lofted foam material of Ethylene Vinyl Acetate copolymer (EVA) resin (commercially known as Levirex ) (1), ‘growth additives’ such as Engage (a flexible thermoplastic polyolefin elastomer manufactured by DuPont Dow, Plaquemine, LA, USA) and ‘pigments depending upon the desired color’ (1). To date there are no reported cases of allergic contact dermatitis (ACD) to Crocs .